All sections of this form must be completed in full – if a section is not applicable to you please insert ‘N/A’

All Service Disruption requests must include a completed ERW form and the TMP/TMD’s

The ERW form and TMP/TMD’s must be attached to the same email

When submitting your service disruption request the subject line must begin with;

The AT Worksites Reference - followed by the street name - then the suburb name

Any Service Disruption requests that do not adhere to the above regulations will be returned to you with a request to submit a correctly/fully completed application. The resubmitted application will then be subject to the 10-working day turnaround beginning the date it is received

You must provide the Service Disruption team with at least 5 business days’ notice before works commence

Notice can only be provided after you have received endorsement for your works. This means the dates provided below are not considered 5 business days’ notice

Notice must be provided via reply to the service disruption email containing the conditions/ endorsement

This condition is applied to all endorsements. To avoid delays to your schedule ensure you submit your request early enough to allow adequate time for processing, and to adhere to this condition

AT Worksites Reference	AT-W
Location	Street
Suburb
Description of Works/ Project Name
Type of TTM (select all that apply)	☐ Shoulder Closure	☐ Contraflow
☐ Bus Stop Closure	☐ One Way Road Closure
☐ Stop/ Go	☐ Full Road Closure
Dates	Start Date	End Date
Select date	Select date
Times	Start Time	End Time
Enter Time
Duration of Works
Duration of Each Stage It is assumed that all stages will be run on consecutive shifts. If any stages are to be carried out within the same shift, or in an order other than 1,2, 3 etc., this must be specified	Stage	Duration
Bus Stops Impacted Stops must be listed here either by stop number or address – "as per TMP" will not be accepted
Stop Number/ Address	Relocated To?	Duration

Submit your service disruption request to Service.Disruptions@at.govt.nz

Please allow up to 10 working days for a response